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Relationships of bronchodilator response with asthma control and fractional exhaled nitric oxide in children with atopic asthma.

Joohyun PARK ; Youn Kyung LEE ; Heon KIM ; Youn Soo HAHN

Allergy, Asthma & Respiratory Disease.2015;3(1):40-46. doi:10.4168/aard.2015.3.1.40

PURPOSE: Because bronchodilator response (BDR) is variable among asthmatic patients, there are practical limitations in using BDR to assess asthma control. We investigated the relationships of BDR with asthma control status and fractional exhaled nitric oxide (FeNO) in children with atopic asthma. METHODS: One hundred ninety-one patients aged 8 to 16 years with atopic asthma were enrolled. Pulmonary function tests including BDR and FeNO were serially measured 10 times or more over 2 years when subjects were not receiving controller medications. During the last year of follow-up, the loss of asthma control was assessed in all participants. RESULTS: We identified 114 children (60%) with at least 1 positive BDR (> or =12%) over the 2-year observation period. Higher levels of BDRs and higher rates of positive BDRs were associated with lower lung function and lower methacholine PC20 (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second). The loss of asthma control occurred in 106 of individuals (93%) who had positive BDRs, as compared to 52 of 77 (68%) with negative BDRs (P<0.001). There was no difference in FeNO levels between individuals with positive and negative BDRs. However, among children with negative BDRs, those developing the loss of asthma control had higher maximal FeNO levels and higher rates of FeNO>21 parts per billion than those who maintained asthma control (all P<0.001). CONCLUSION: Positive BDRs are linked to a higher probability of asthma control loss in children with atopic asthma. In addition, high FeNO is associated with asthma control loss in asthmatic children with negative BDRs.
Asthma* ; Child* ; Follow-Up Studies ; Forced Expiratory Volume ; Humans ; Lung ; Methacholine Chloride ; Nitric Oxide* ; Respiratory Function Tests

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Relationship between serum 25-hydroxyvitamin D and lung function among Korean adults.

Young Wook KIM ; Dong Soo RYU ; Ju Suk LEE

Allergy, Asthma & Respiratory Disease.2015;3(1):35-39. doi:10.4168/aard.2015.3.1.35

PURPOSE: The relationship between vitamin D status and pulmonary function has been investigated in several studies. But previous study results are controversial. We want to know the relationship between vitamin D status and pulmonary function in Korean adults in small regional area. METHODS: The medical records of 3,253 subjects were reviewed retrospectively, those visited for routine health examination in Samsung Changwon Hospital between January and December 2013. All of them were workers in one company and lived in one island ('Geojedo'). RESULTS: Vitamin D deficiency group (serum 25-hydroxyvitamin D [25(OH)D]<20 ng/mL) showed lowed % forced vital capacity in one second (%FEV1; P<0.01), forced vital capacity (FVC; P<0.01) and higher FEV1/FVC (P<0.01). Serum 25(OH)D was positively correlated with %FEV1 (R=0.035, P<0.05), %FVC (R=0.081, P<0.01), FVC (R=0.125, P<0.01) and negatively with FEV1/FVC (R=-0.083, P<0.01). After adjustment for smoking history, we found serum 25(OH)D level was positively correlated with %FVC (R=0.058, P<0.01), FVC (R=0.093, P<0.01) and negatively with FEV1/FVC (R=-0.055, P<0.01). After adjustment for smoking and asthma history, we found serum 25(OH)D level was positive correlated with %FVC (R=0.103, P<0.01) and negatively with FEV1/FVC (R=-0.119, P<0.01). CONCLUSION: Serum 25(OH)D level was associated with pulmonary function.
Adult* ; Asthma ; Forced Expiratory Volume ; Gyeongsangnam-do ; Humans ; Lung* ; Medical Records ; Respiratory Function Tests ; Retrospective Studies ; Smoke ; Smoking ; Vital Capacity ; Vitamin D ; Vitamin D Deficiency

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Critical pathway of acute asthma attack for the Emergency Center: patients' outcomes and effectiveness.

Dong Woo LEEM ; Kyung Hee PARK ; Il Joo MOON ; Sung Ryeol KIM ; Beom Seok KOH ; Hye Jung PARK ; Jae Hyun LEE ; Jung Won PARK

Allergy, Asthma & Respiratory Disease.2015;3(1):30-34. doi:10.4168/aard.2015.3.1.30

PURPOSE: Early recognition and management of asthma attack is critical before it becomes worse. We developed critical pathway (CP) of asthma attack at Emergency Center (EC) for making undelayed decision and management of asthma attack. METHODS: Acute asthma attack assessment and treatment (4AT) CP began on April 1st 2012 and recruited the patients for 18 months. This study enrolled the patients who were older than 15 years and visited EC for dyspnea and wheezing. Initial assessment was done measuring peak expiratory flow rate (PEFR), oxygen saturation (SaO2). Once CP is activated, oxygen, inhalation of short acting beta2 agonist, and injection of corticosteroid were administered to the patients. Every hour after CP activated, we reassess the patients' response and make decisions whether to admit or discharge. RESULTS: Until January 10th 2014, 62 patients enrolled in this study. Seven patients hospitalized for asthma and 40 patients discharged. The other 15 patients were deactivated as they were diagnosed of heart failure, myocardial infarction, aortic dissection, anaphylaxis, chronic obstructive pulmonary disease and pneumonia for the causes of dyspnea. Mean Interval from EC arrival to 4AT activation was 32.6+/-29.1 minutes and the mean interval from 4AT activation to position decision was 254.5+/-302.0 minutes. Among 47 patients who were diagnosed with asthma attack, 13 patients were not aware of asthma before this attack. Forty patients were discharged at EC after management of CP. Among them, 34 patients revisited clinic, but 6 patients did not. We called back to the lost 6 patients but only 3 patients were connected. Even they visited EC due to asthma attack, 2 patients had no insight of importance of regular management and the other one promised to revisit. CONCLUSION: CP was successful for early management of asthma attack. However, 15% of discharged patients never show up again. So, education program about the importance of ongoing management of asthma for prevention of asthma attack is needed.
Anaphylaxis ; Asthma* ; Critical Pathways* ; Dyspnea ; Education ; Emergencies* ; Emergency Treatment ; Heart Failure ; Humans ; Inhalation ; Myocardial Infarction ; Oxygen ; Peak Expiratory Flow Rate ; Pneumonia ; Pulmonary Disease, Chronic Obstructive ; Respiratory Sounds

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Diagnostic utility of skin prick test to cooked egg in children with egg allergy.

Jin JHON ; Kyung Eun LEE ; Mi Na KIM ; Jung Yeon HONG ; Min Jung KIM ; Yoon Hee KIM ; Hyun Bin PARK ; Yoon Ki HAN ; Hee Seon LEE ; Kyung Won KIM ; Myung Hyun SOHN ; Jung Won PARK ; Kyu Earn KIM

Allergy, Asthma & Respiratory Disease.2015;3(1):22-29. doi:10.4168/aard.2015.3.1.22

PURPOSE: Reliable predictors of tolerance to cooked egg in an egg allergic population are not established. We investigated the usefulness of the skin prick test to cooked egg in children with egg allergy. METHODS: We studied 36 children with egg allergy. Skin prick tests (SPTs) for the uncooked or cooked form of egg white and egg yolk, whole egg, ovomucoid (OVM), and ovalbumin (OVA) were performed at diagnosis. The reagents of cooked egg for SPT were prepared by baking for 25 minutes in 200 degree oven. We also examined specific IgE levels to whole egg, egg white, egg yolk, OVM, and OVA. RESULTS: Patients with history of allergic reaction to extensively heated egg showed significantly increased wheal size for cooked egg white (median [interquartile range]), 10.5 [7.0-14.6] vs. 4.2 [0.0-5.6], P<0.001) and OVM (9.6 [7.3-13.8] vs. 5.6 [0.0-7.8], P=0.001) than those without the history. The strongest positive correlation was found between wheal size for cooked egg white and OVM (r=0.788, P<0.001). SPT wheal size for cooked egg white were positively correlated with serum OVM-specific IgE levels (r=0.691, P<0.001). Cutoff value was 7.0 mm in SPT wheal size for cooked egg white, the sensitivity was 73.1% and specificity was 99.0%. SPT for cooked egg white showed significantly higher area under curve than serum egg white specific IgE. CONCLUSION: Our results suggest that SPT to cooked egg white may be useful predictor of allergic reaction to cooked egg. Further investigations will be needed.
Area Under Curve ; Child* ; Diagnosis ; Egg Hypersensitivity* ; Egg Proteins ; Egg White ; Egg Yolk ; Hot Temperature ; Humans ; Hypersensitivity ; Immunoglobulin E ; Indicators and Reagents ; Ovalbumin ; Ovomucin ; Ovum* ; Skin Tests ; Skin*

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Update on egg allergy in children.

Meeyong SHIN

Allergy, Asthma & Respiratory Disease.2015;3(1):15-21. doi:10.4168/aard.2015.3.1.15

Egg allergy is one of the most common food allergies in children and has a wide spectrum of clinical presentation including anaphylaxis. Many studies suggested egg-specific IgE cutoff values (diagnostic decision point) and skin prick test size that predict a clinical allergic reaction without oral food challenges. Some patients may react to all forms of egg including raw egg, but many egg-allergic patients tolerate baked egg products. A few studies reported that a high concentration of ovomucoid-specific IgE antibody indicates a high risk of reacting to heated egg white. Recently it has been suggested that regular ingestion of baked egg products may hasten tolerance development. Egg allergy may be more persistent than previously thought. The treatment of egg allergy still relies on dietary avoidance of egg-containing foods until tolerance has developed. In recent years there has been increasing success in clinical trials of egg oral immunotherapy, and oral immunotherapy can be a promising treatment modality for providing protection from reactions caused by accidental egg exposure. However, concerns regarding the safety and long-term efficacy still preclude the general use of oral immunotherapy in clinical practice. In this article, the recent literature regarding egg allergens, clinical presentation, diagnosis, management and natural history of egg allergy will be reviewed.
Allergens ; Anaphylaxis ; Child* ; Diagnosis ; Eating ; Egg Hypersensitivity* ; Egg White ; Food Hypersensitivity ; Hot Temperature ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunotherapy ; Natural History ; Ovomucin ; Ovum ; Skin

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KAAACI Work Group report on the management of chronic urticaria.

Young Min YE ; Gwang Cheon JANG ; Sun Hee CHOI ; Jeongmin LEE ; Hye Soo YOO ; Kyung Hee PARK ; Meeyong SHIN ; Jihyun KIM ; Suh Young LEE ; Jeong Hee CHOI ; Youngmin AHN ; Hae Sim PARK ; Yoon Seok CHANG ; Jae Won JEONG ; Sooyoung LEE

Allergy, Asthma & Respiratory Disease.2015;3(1):3-14. doi:10.4168/aard.2015.3.1.3

Chronic urticaria (CU) is defined by the presence of urticaria that has been continuously or intermittently for a period of 6 weeks or longer. The prevalence of CU in the general population has been estimated to range from 0.5% to 5%. Correct diagnosis and proper management for CU is essential to improve the quality of care. To date, several practical guidelines have been available for practitioners. In this article, we reviewed and summarized the epidemiology, pathogenesis, diagnosis, and management based on case reports and studies of CU from Korea and the other part of world, and recently published guidelines. Although there are many controversies, this report for CU would provide a clinical guidance for healthcare professionals in Korea.
Delivery of Health Care ; Diagnosis ; Epidemiology ; Korea ; Prevalence ; Urticaria*

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Is it necessary to put "cutoff levels of food specific IgE" in between the glass and the table in your office?.

Jinho YU

Allergy, Asthma & Respiratory Disease.2015;3(1):1-2. doi:10.4168/aard.2015.3.1.1

No abstract available.
Glass*

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Unusual reaction to Hymenoptera stings.

Suk Hwan IN ; Young Cheol SHIN ; Eui Kwon HWANG ; Hae Won YOU ; Jun IL KIM ; June Hyuck PARK ; An Soo JANG

Allergy, Asthma & Respiratory Disease.2016;4(4):305-307. doi:10.4168/aard.2016.4.4.305

Reactions to Hymenoptera stings are classified into local reactions, large local reactions, systemic anaphylactic reactions, systemic toxic reactions, and unusual reactions. They are also classified into immediate and delayed reactions. The most frequent clinical patterns are large local and systemic anaphylactic reactions. The skin, and the gastrointestinal, respiratory, and cardiovascular systems can be involved. A variety of unusual or unexpected reactions, such as acute encephalopathy, acute renal failure, nephrotic syndrome, silent myocardial infarction, diffuse alveolar hemorrhage, rhabdomyolysis, and cataracts, occur in a temporal relationship to insect stings. Here, we report a 31-year-old woman with delayed generalized edema, weight gain, and unusual reactions 24 hours after bee sting.
Acute Kidney Injury ; Adult ; Anaphylaxis ; Bees ; Bites and Stings* ; Brain Diseases ; Cardiovascular System ; Cataract ; Edema ; Female ; Hemorrhage ; Humans ; Hymenoptera* ; Insect Bites and Stings ; Myocardial Infarction ; Nephrotic Syndrome ; Rhabdomyolysis ; Skin ; Weight Gain

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Methazolamide-induced toxic epidermal necrolysis confirmed by lymphocyte activation test.

Kyu Hyung HAN ; Ku Hyun HONG ; Doh Hyung KIM ; Youn Seup KIM ; Jae Suk PARK ; Seung Heon KIM ; Young Koo JEE

Allergy, Asthma & Respiratory Disease.2016;4(4):301-304. doi:10.4168/aard.2016.4.4.301

Among various dermatological entities, toxic epidermal necrolysis (TEN) is a rare but potentially fatal delayed hypersensitivity reaction to numerous medications. A 38-year-old male presented with systemic hypersensitivity reaction, such as high fever, pain in the eyes, and diffuse pruritic erythematous maculopapular eruptions with multiple targetoid plaques that became vesicular and bullous. Oral mucosa and conjunctivae were involved. The first sign appeared about 1 week after taking methazolamide (50 mg twice a day) for the management of glaucomatous eyes. Although methazolamide was discontinued, blistering and skin denudation progressed to affect up to 80% of the body surface area and a positive Nikolsky sign was noted. High fever also persisted. Skin lesions started to improve after 2 weeks of management and fever subsided. Cutaneous lesions improved with minimal permanent sequele 2 months later. HLA-B*5901 was found by high-resolution genotyping. The lymphocyte activation test performed 6 months after remission showed a positive response to methazolamide challenge. This is the first case of methazolamide-induced TEN in which methazolamide was confirmed as a culprit drug by the lymphocyte activation test.
Adult ; Blister ; Body Surface Area ; Conjunctiva ; Fever ; Humans ; Hypersensitivity ; Hypersensitivity, Delayed ; Lymphocyte Activation* ; Lymphocytes* ; Male ; Methazolamide ; Mouth Mucosa ; Skin ; Stevens-Johnson Syndrome*

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Drug reaction with eosinophilia and systemic symptom induced in a 9-year-old boy.

Han Sol SONG ; Woo Hyeok CHOI ; Won Bok CHOI ; Seung YANG ; Il Tae HWANG ; Hey Sung BAEK

Allergy, Asthma & Respiratory Disease.2016;4(4):296-300. doi:10.4168/aard.2016.4.4.296

The drug reaction with eosinophilia and systemic symptom (DRESS) is a severe adverse drug-induced reaction. Acetaminophen is extensively used as an over-the-counter drug as well as a medical therapeutic. In spite of its frequent use, drug eruptions related to DRESS caused by acetaminophen are rare. This case report describes a 9-year-old boy who experienced fever and maculopapular skin rashes after taking acetaminophen. Leukocytosis with marked eosinophilia and slightly elevated levels of liver enzymes were observed. Symptoms resolved after withdrawal of acetaminophen, followed by intravenous methylprednisolone administration. The diagnosis of DRESS induced by acetaminophen was confirmed by an oral challenge test after 2 months. No allergic reactions to ibuprofen were observed.
Acetaminophen ; Child* ; Diagnosis ; Drug Eruptions ; Drug Hypersensitivity ; Eosinophilia* ; Exanthema ; Fever ; Humans ; Hypersensitivity ; Ibuprofen ; Leukocytosis ; Liver ; Male* ; Methylprednisolone

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